Mouse clicks replacing stethoscopes

Health insurers want you to see the doctor, just not in an office or hospital.

To cut medical costs and diagnose minor ailments, WellPoint Inc. and Aetna Inc., among other health insurers, are letting millions of patients get seen online first. In a major expansion of telemedicine, WellPoint last month started offering 4 million patients the ability to have e-visits with doctors, while Aetna says it will boost online access to 8 million people next year from 3 million now.

The insurers are joining with companies such as Teladoc Inc., MDLive Inc. and American Well Corp. that offer virtual visits with doctors who, in some states, can prescribe drugs for anything from sinus infections to back pain.

While patients with time constraints like the idea, some doctors say they worry that online visits may offer a higher potential for wrong diagnosis. For example, a stomach ache may be nothing, or it could be appendicitis, said R. Adams Dudley, at the University of California, San Francisco.

“Just one little touch can make a big difference” to feel where the pain is at, said Dudley, a professor of medicine and health policy at the school.

For symptoms doctors need to see, “some computer screens just don't have the best resolution, and you can't really adjust the lighting.”

That can make it difficult for even something as simple as looking for a film at the back of the mouth or finding excess pus in the sinuses — signs that help determine whether a patient needs antibiotics or simply has a common cold that will go away on its own, Dudley said.

The board-certified physicians involved in the practice don't necessarily disagree.

Peter Antall, a pediatrician, heads the Online Care Group, which provides doctors for American Well. He says that while “there are some things we can't do,” he's confident doctors from his group have the skills to know when more intense care is needed.

The American Medical Association earlier this year offered new guidelines to shape telemedicine's development and state licensing boards have agreed on their own draft policy in April.

The discussion promises to escalate as patients become increasingly sophisticated in their online pursuits, delays in making doctor appointments grow longer, and the cost of services provided by medical centers increases.

“More and more patients are comfortable seeing a physician online,” said CEO Jonathan Linkous of the American Telemedicine Association. “It's an adoption process. They understand it, and use it.”